脊柱节段血管阻断对椎间盘退变发生发展的影响

目的：探讨结扎脊柱节段血管对椎间盘退变发生发展的影响。方法：16只成年犬随机平均分为两组．每只犬均结扎左侧T6～T9的节段血管。分别于造模后3个月和8个月急性失血法各处死一组动物，处死后立即取整段胸椎。T6，7至T8／9为实验区(结扎节段血管区)，取结扎血管以上的T4／5椎间盘为病理检查中的对照区，T6／7为病理检查实验区；T7／8和F8/9椎间盘为生化分析的实验区，结扎血管以下的T11/12、T12／13椎间盘为生化分析的对照区。对对照区和实验区内椎间盘的形态和成分进行比较。结果：与对照组相比．实验组的椎间盘在3个月时胶原成分已有显著增加，而糖胺多糖成分显著降低；8个月组与3个月组无显著性区别。结论：在脊柱节段血管阻断后，椎间盘的周围血供减少，影响椎间盘的营养供应，可诱发或加速椎间盘的退变。     

Physicochemical properties of the aging and diabetic sand rat intervertebral disc.

Hydration, fixed charge density, (FCD) and hydration under various osmotic pressures were compared in young, old, and young diabetic sand rats. This rat is a desert animal that may develop diabetes when fed a regular diet; it is also known to have radiographic and histologic evidence of intervertebral disc (IVD) disease. Forty-five rats and 180 IVD were used in this study; they were divided into three equal groups: young healthy, old healthy, and young diabetics. IVD, cancellous bone, and muscle were sampled from distal lumbar spines. The young diabetic rats (YD) were considerably heavier than the age-matched controls, had higher insulin and glucose levels, and all YD had cataracts. The discs of the young diabetic animals demonstrated decreased hydration, FCD and ability to resist compression under osmotic pressures as compared with the young and healthy discs and were more similar to the discs from old rats. The IVD is the most affected musculoskeletal connective tissue in sand rats with aging and diabetes. The aged and diabetic discs in the sand rat demonstrated changes similar to human changes with regard to lower hydration, FCD, and ability to resist osmotic pressure. Therefore, the sand rat may be a suitable animal model for studying the pathogenesis of disc degeneration.     

Correlating magnetic resonance imaging with the biochemical content of the normal human intervertebral disc.

Magnetic resonance imaging was used to determine the T2 relaxation times of prepared proteoglycan solutions and of normal human intervertebral disc tissue from the annulus fibrosus (AF) and nucleus pulposus (NP). The collagen, proteoglycan, and water contents of the disc tissue samples were determined by biochemical assays after they were scanned. Correlations among 1/T2, collagen, proteoglycan, and water contents of the tissue samples and among 1/T2, water, and proteoglycan contents of the proteoglycan solutions were calculated. A moderate negative correlation between 1/T2 and water content was noted for the tissue samples, and a very high negative correlation was found between 1/T2 and water content for the proteoglycan solutions. The very high positive correlation between 1/T2 and proteoglycan content of the proteoglycan solutions is probably due to this negative correlation between 1/T2 and water content. There was no significant correlation between 1/T2 and proteoglycan content of the tissues. The moderate positive correlation between 1/T2 and collagen content is probably due to the high negative correlation between collagen content and water content. No significant correlation was found between the collagen and proteoglycan contents of the tissues. Thus it appears that the data confirm previous reports in the literature that the collagen of the disc tissue functions to control its water content.     

The lumbar intervertebral disc: From embryonic development to degeneration

Lumbar intervertebral discs (IVDs) are prone to degeneration upon skeletal maturity. In fact, this process could explain approximately 40% of the cases of low back pain in humans. Despite the efficiency of pain-relieving treatments, the scientific community seeks to develop innovative therapeutic approaches that might limit the use of invasive surgical procedures (e.g., spine fusion and arthroplasty). As a prerequisite to the development of these strategies, we must improve our fundamental knowledge regarding IVD pathophysiology. Recently, several studies have demonstrated that there is a singular phenotype associated with Nucleus pulposus (NP) cells, which is distinct from that of articular chondrocytes. In parallel, recent studies concerning the origin and development of NP cells, as well as their role in intervertebral tissue homeostasis, have yielded new insights into the complex mechanisms involved in disc degeneration. This review summarizes our current understanding of IVD physiology and the complex cell-mediated processes that contribute to IVD degeneration. Collectively, these recent advances could inspire the scientific community to explore new biotherapeutic strategies.     

一氧化氮合酶抑制剂对延缓腰椎间盘退变的影响

目的　探讨一氧化氮合酶(NOS)抑制剂L N6 亚氨乙基 赖氨酸(L NIL)和S 甲基异硫脲(SMT)对退变腰椎间盘组织代谢的影响。方法　无菌条件下,取2 0例腰椎间盘突出症患者的椎间盘组织体外培养,分别加入1mmol/L浓度的SMT和L NIL ,培养72h后,通过检测硝酸盐和亚硝酸盐的含量来观察椎间盘NO的释放量及NOS的活性;原位杂交法检测椎间盘组织iNOSmRNA和MMP3mRNA的表达。培养10d后,化学比色法观察椎间盘蛋白多糖含量和羟脯氨酸释放量的变化。结果　L NIL组髓核和纤维环NO释放量(65 .6±4.5 ,68.8±5 .7) μmol/L和SMT组髓核和纤维环NO释放量(69.5±6.5 ,69.1±6.1) μmol/L较对照组NO释放量(10 7.9±4.4,93 .1±5 .9) μmol/L明显减少(P <0 .0 1)。L NIL组和SMT组髓核组织中蛋白多糖含量(5 1.3±9.6,48.2±8.5 )kg/L ,比对照组(3 2 .1±6.4)kg/L明显增加(P <0 .0 1) ,羟脯氨酸释放量(1.1±0 .4,1.2±0 .5 )kg/L比对照组(3 .4±0 .8)kg/L显著减少(P <0 .0 1) ;同时,原位杂交法未检测到iNOSmRNA和MMP3mRNA的表达。结论　NOS抑制剂L NIL和SMT能抑制过量NO的释放,对延缓椎间盘退变具有积极的作用     

椎间盘镜治疗中央型腰间盘突出症附38例临床报告

腰椎间盘突出症是骨科常见病、多发病,其发病率日趋增高,治疗中央型间盘突出以手术为主,传统术式是全椎板切除,经硬膜囊内(或牵开硬膜囊)摘除突出变性的间盘组织,手术破坏了脊柱后柱,增加了脊柱的不稳定性,以致后期腰椎不稳,再次出现腰腿疼症状.随着微创技术引入脊柱外科,椎间盘镜下髓核摘除术的应用避免了后期脊柱不稳的发生,我院2001年初开展此技术,治疗中央型间盘突出38例,取得满意效果,初步报告如下.……     

Estrogen receptor expression in lumbar intervertebral disc of the elderly: Gender- and degeneration degree-related variations

ObjectivesSexual dimorphism does occur in intervertebral disc (IVD) degeneration. The involvement of estrogen on IVD health has been well reported in recent years. The estrogen receptors (ER) are the main mediators of estrogen action. ER might play specific roles in the sexual variations of the IVD degeneration.MethodsThirty-six elderly patients with lumbar disc degeneration were selected and graded using Pfirrmann's system based on MRI images. Differences of ERα and ERβ immunoreactivity staining in nucleus pulposus of each sex and degeneration degree were recorded and compared.ResultsBoth cytoplasmic and nuclear staining of ERα and ERβ immunoreactivity were observed in the nucleus pulposus cells. ERα and ERβ expression significantly decreased along with the aggravation of IVD degeneration both in males and females. Expression of ERα and ERβ protein in nucleus pulposus of males was significantly higher than that of females.ConclusionsGender-specific expression of ER might play a part in sexual dimorphism of IVD degeneration. Gender and degeneration condition differences should be taken into account when the effects of estrogen on IVD metabolism are studied further.     

椎间盘移植实验—生物化学研究

恒河猴１２只，于Ｌ＿（３￣４）行自体间盘移植手术。对术后不同时间移植间盘进行生化分析，测定了间盘组织的水、胶原和蛋白多糖含量变化，结果显示：术后２月蛋白多糖及水含量降低，胶原含量升高，髓核较纤维环变化明显。术后４月蛋白多糖及水含量进一步降低，胶原含量回升，与对照组已无统计学差异，水份和胶原含量较，４月无明显变化。提示：椎间盘移植后虽然在早朝有退变倾向，但在后期这种退变部分恢复。     

Effect of age on the abundance and fragmentation of link protein of the human intervertebral disc

The link proteins of the human intervertebral disc were studied in tissue extracts by sodium dodecyl sulfate/polyacrylamide gel electrophoresis (SDS/PAGE), followed by immunoblotting, using a specific monoclonal antibody. Three link proteins were detected, corresponding in electrophoretic mobility to those present in articular cartilage. As with articular cartilage, the largest link protein predominates in the young, whereas in the adult the smallest link protein is equally abundant and internal fragmentation of the link proteins occurs. Only in the newborn is the quantity of extractable link protein comparable to that from articular cartilage. In the adult, the disc contains much less link protein than is present in autologous articular cartilage. Neither the amount nor heterogeneity of the link protein differs among different levels within the lumbar spine, although the proportions of the three proteins can differ between the anulus fibrosus and nucleus pulposus. The anulus always contained more extractable link protein relative to tissue wet weight than the nucleus, and the nuclear link protein, at least in adolescents, contained a greater proportion of the smallest link protein. Such changes in the quantity and structure of the disc link proteins may affect the properties of the proteoglycan aggregates and, thus, could influence disc function.     

胶原酶髓核溶解术治疗腰椎间盘突出症概述

胶原酶髓核溶解术是治疗腰椎间盘突出症的一种有限手术,将胶原酶注入突出的椎间盘中或突出髓核周围,通过该酶催化降解髓核的胶原成分,降低髓核内的压力,使突出的椎间盘缩小或回复,减轻或解除对神经根的压迫,达到缓解或消除症状的目的.该方法是介于保守治疗与外科手术之间的方法,1968年哈佛大学医学院Sussman[1]首先提出用胶原酶替代木瓜凝乳蛋白酶溶解突出椎间盘,随后有更多的学者致力于该方法的研究.本文对胶原酶髓核溶解术治疗腰椎间盘突出症的实验与临床研究进展综述如下.……     

Histochemical and ultrastructural observations on brown degeneration of human intervertebral disc

Thirty-eight fresh human intervertebral discs collected during anterior interbody fusion surgery were histochemically and ultrastructurally analyzed for pigments. Macroscopically, five stages of degeneration were classified according to the color, fibrosis, and fragility of the nucleus pulposus of the discs. In order to demonstrate lipofuscin granules, specimens were subjected to special staining procedures, including carbol fuchsin lipofuscin stain, the Schmorl's reaction, and autofluorescence. Lipofuscin granules were distributed from the inner layer of the annulus fibrosus to the nucleus pulposus. Such granules were numerous in cases of slight or severe degeneration, whereas fewer granules were found in cases of moderate degeneration. However, the stage of macroscopic degeneration of the intervertebral disc did not necessarily correlate with the incidence of lipofuscin granules. By ultrastructural observation, the morphological features of the components of the intervertebral disc and the ultrastructure of the lipofuscin granule were clarified. The ultrastructure of the "brown degeneration" disc exhibited markedly increased amorphous electron-dense bodies located among collagen fibrils in the matrix.     

腰椎间盘突出症的病理及临床分型

洛阳正骨医院,河南洛阳 471002 腰椎间盘突出症(Lumbar disc herniation,LDH)是骨科临床常见病和多发病,是腰腿痛的常见原因.LDH的分型方法较多[1,2],本文就腰椎间盘突出症的病理及临床分型进行探讨,现简述如下.     

腰椎间盘突出上移症

1　病例介绍病例 1,女 ,4 8岁 ,农民。因腰扭伤疼痛向右下肢放射痛3年来院就诊。体格检查 :腰生理弯曲变直 ,Ｌ3 ,4、Ｌ4,5右旁叩痛阳性 ,右直腿抬高试验 2 0°阳性 ,右足下垂 ,右膝反射消失 ,右侧股四头肌肌力Ⅲ级 ,右大腿外及右小腿前内侧和右小腿外及右足背皮肤感觉麻木。ＣＴ检查示 :Ｌ4,5右偏型椎间盘突出 ,Ｌ3 ,4未见椎间盘突出。腰椎管造影Ｘ线片示 :Ｌ4,5椎间隙严重变窄 ,平齐第 4腰椎右侧椎管内组织及腰 4和腰 5右侧神经根明显压迫影像 ,造影剂充盈缺损 (图 1)。诊断为Ｌ4,5右偏型椎间盘突出上移伴高位神经压迫。施行Ｌ4,5后路右侧…     

三维牵引治疗腰椎间盘突出症

九十年代中期以来,三维牵引作为保守治疗腰椎间盘突出症(LDH)的一种新方法出现[1]。因其成本低廉、安全性高、效益可观,在短时间内得到了迅速推广。但是由于对治疗机理缺乏理解,操作中出现滥用和疗效不佳的现象。我院从1995年1月~2000年1月采用三维牵引为主的方法LDH患者1000例,现将治疗中的一点体会总结如下。     

Biological and mechanical consequences of transient intervertebral disc bending

Degenerative mechanisms for the intervertebral disc are unclear, particularly those associated with cumulative trauma. This research focuses on how mechanical loading at levels below those known to cause acute trauma can lead to cellular injury. Mouse-tail discs were subjected to static bending for 1 week, then allowed to recover unloaded for 3 weeks and 3 months. Discs were analyzed using histology, in situ hybridization (collagen and aggrecan gene expression), TUNEL assay for apoptotic cell death, and biomechanics. The bent discs demonstrated loss of annular cellularity on the concave (compressed) side, while the nucleus and convex annulus appeared normal. Chondrocyte-like cells were apparent within the inner, concave annulus on the recovered discs, with evidence of proliferation at the annulus/endplate interface. However, annular architecture and biomechanical properties for the recovered discs were not different from controls, suggesting that restoration of physiologic tissue stress prevents the inner annular degradation noted in previous compression-induced degeneration models. These data demonstrate that cellular injury can be induced by transient compressive stress, and that recellularization is slow in this avascular tissue. Taken together, this suggests that cellular damage accumulation may be an important injury mechanism that is distinct from acute mechanical failure.     

Effects of axial traction stress on solute transport and proteoglycan synthesis in the porcine intervertebral disc in vitro

Summary The effects of axial traction stress on intradiscal hydration, solute transport and proteoglycan synthesis were examined in 658 porcine coccygeal intervertebral discs in vitro. Measurements were performed in three tissue fractions: nucleus pulposus, inner and outer annulus fibrosus. At 0.80 MPa traction stress, the equilibrium hydration did not change in the nucleus pulposus. However, in the inner and outer annulus, the equilibrium hydration was reduced, and the change led to an increase of the effective fixed charge density. Diffusion of solute to the nucleus pulposus was significantly suppressed at 0.80 MPa traction stress. The fluid flow of the intervertebral disc tended to be suppressed during the creep recovery process after compression. The proteoglycan synthesis rate in the outer annulus was markedly suppressed by traction stress of 0.80 MPa for 4 h, but not that in the nucleus pulposus. These results suggest that a prolonged excessive axial traction stress induces a decrease in tissue hydration in the annulus fibrosus, and this may lead to an increase in the fractional volume of solid in the matrix and tissue osmotic pressure, resulting in diffusion inhibition of solute and suppression of proteoglycan synthesis. Thus, prolonged and excessive spinal traction may accelerate disc degeneration.Presented at the annual meeting of the International Society for the Study of the Lumbar Spine, May 12–16, 1991, Heidelberg, Germany     

Correlation of radiographic and MRI parameters to morphological and biochemical assessment of intervertebral disc degeneration

Degenerative disc disease (DDD) is a common finding in MRI scans and X-rays. However, their correlation to morphological and biochemical changes is not well established. In this study, radiological and MRI parameters of DDD were assessed and compared with morphological and biochemical findings of disc degeneration. Thirty-nine human lumbar discs (L1–S1), age 19–86 years, were harvested from eight cadavers. Within 48 h postmortem, MRIs in various spin-echo sequences and biplanar radiographs of intact spines were obtained. Individual discs with endplates were then sectioned in the mid-sagittal plane and graded according to the morphological appearance. Samples from the nucleus of each disc were harvested for biochemical analysis including water and proteoglycan contents. On MRIs, T2-signal intensity, Modic changes, disc extension beyond the interspace (DEBIT), nucleus pulposus shape, annular tears, osteophytes and endplate integrity were graded. On radiographs, an independent observer classified the parameters disc height, endplate sclerosis, osteophytes, Schmorls nodes, intradiscal calcifications and endplate shape. General linear-regression models were used for statistical analysis. Backward elimination with a 10% significance cut-off level was used to identify the most significant parameters, which then were summed to create composite scores for radiography, MRI and the combination of both methods. The grading was performed by three observers, and a reliability analysis using Cronbachs alpha model was used to control interobserver agreement. The three radiographic parameters height-loss, osteophytes and intradiscal calcifications correlated significantly with the morphological degree of degeneration (p<0.001, R²=642). Significant differences of even one morphological grade could also be differentiated in the composite radiological score (p<0.05), except at the extremes between grades 1 and 2 and grades 4 and 5. All MRI parameters correlated significantly with the morphological grade (p<0.05); however Modic changes, T2-intensity and osteophytes accounted for 83% of the variation in the data. T2-signal intensity correlated significantly with H₂O and proteoglycan content (p<0.001), and was best for detecting highly degenerated discs. Regression showed that the combined score was better correlated with the morphological grade (p<0.001, R² =775) than either the composite radiographic (p<0.001, R² =642) or composite MRI (p<0.001, R² =696) alone. Based on the combined score, a backwards elimination of the regression was performed, in which the parameters Modic changes, and T2-intensity loss (MRI) as well as calcifications (X-ray) accounted for 87% of the variability. The interobserver validation showed a high correlation for all three scores (Cronbachs alpha values ranging from 0.95 to 0.97). Conclusion: selective imaging parameters and a newly created scoring scheme were found to correlate with disc degeneration as determined in a morphological manner. Surprisingly, radiographic parameters were able to distinguish different stages of degeneration, whereas MRI could only detect advanced stages of disc degeneration. We conclude that X-rays may remain a cost-effective, non-invasive in vivo-grading method to detect early disc degeneration, and, combined with MRI, correlate best with morphological and biochemical assessment of disc degeneration.     

Identification of human intervertebral disc stromelysin and its involvement in matrix degradation.

Human intervertebral disc when maintained in organ culture released a latent casein-degrading metalloproteinase into the medium in a manner analogous to cultures of human cartilage. This enzyme was demonstrated to be immunologically identical to prostromelysin. It was also found that the amount of procollagenase secreted by both cartilage and disc cells was considerably less than that of prostromelysin. Tissue extraction confirmed that the low level of procollagenase observed was not due to retention of the enzyme within the tissue. Human intervertebral disc link proteins were found to possess the same N-termini as those of their counterparts in human articular cartilage, where it appears that stromelysin is responsible for generating molecular heterogeneity. These results suggest that intervertebral disc cells are capable of secreting prostromelysin, which can become activated within the extracellular matrix and hence contribute to the age-related and degenerative changes in the disc.     

保守治疗椎间孔外型腰椎间盘突出症

随着CT应用的普及，椎间孔外型腰椎间盘突出症作为腰椎间盘突出症的特殊类型，逐渐被人认识，确诊率明显提高，我科自1999年～2003年共收治腰椎间盘突出症患者794例，其中确诊为椎间孔外型腰椎间盘突出症者其15例，占1.89%，手术治疗3例，保守治疗12例，获得了满意的效果，现将保守治疗的12例报告如下。